Archive for November 13th, 2012

Today’s federal post-election update was written by Kate Seif, the Alliance’s Policy Outreach Coordinator. The state post-election update was written by Lisa Stand, Senior Policy Analyst with the Alliance.

Eye on the Federal

President Obama won the election; the Republican Party maintained its majority in the House of Representatives; and the Democrats kept their majority in the Senate. It may look as though little has changed, but looks can be deceiving. Elections always mean change.

In Congress, both the House and Senate have a host of new members, while some long-term incumbents (and some new ones) have retired, resigned, or otherwise moved positions, paving the way for congressional committee reassignments and possible leadership changes. Many districts have been redrawn thanks to the decennial redistricting resulting from the Census, and that has left many constituents with new Representatives.

While the resident of the White House isn’t going anywhere, the 15 Executive Cabinet Members can (and often do) go elsewhere between terms. The same is true for a host of lower-level positions. No announcements on that front, so far, though.

The question we in the Alliance are asking is how will these changes impact homelessness? The short answer is that right now, just days after the election, we don’t know. During the run-up to the election there was a lot of talk about the need for bipartisanship, and about crossing the aisle and working together. If that kind of talk translates into action, we could see progress.

Federal movement around preventing and ending homelessness has a long history of bipartisan support, with members of both parties working together to make an impact. We hope to see more of that in the weeks and months to come.

Post-election, there is a lot more certainty about the future of the Affordable Care Act (ACA) – and some clear direction for people working to end chronic homelessness in their communities. The health care reform law passed narrowly in 2010, with key provisions not intended to take effect in 2014. The lengthy lead time gave ACA opponents – among them candidate Mitt Romney – the opportunity to campaign to repeal it. With the ACA’s chief proponent Barack Obama now re-elected to a second term, the American public can expect the federal government to carry on with implementation.

Eye on the States

However, because of a Supreme Court ruling earlier this year, debates about health care reform will continue in many states, and pick up pace as the 2014 implementation approaches. That is because the Supreme Court said that the decision to expand Medicaid as the ACA envisions is a state decision, not a matter of federal mandate. Though a number of states have fully embraced the ACA, not every state will immediately opt to expand its Medicaid program, even though the ACA offers generous subsidies to states to do so.

As homeless advocates well understand, the ACA on paper could extend Medicaid to virtually all chronically homeless people who do not already qualify for Medicaid disability. In fact, many people who are chronically homeless lack any health care coverage or a regular source of care for serious physical and behavioral health conditions. Local safety net programs are often burdened as a result – in the health care system as well as homeless assistance system. Clearly, by embracing the ACA and expanding Medicaid, states can boost the overall funding for those health care services in permanent supportive housing – the best approach to ending chronic homelessness.

At the same time that states consider their options for 2014, other ACA provisions are taking effect, as the law intended. One example is creation of person-centered health homes, which are already being implemented in some states. The health home benefit is a possible funding source for care coordination activities that help people stabilize in supportive housing. The Alliance recently published a policy brief about health homes, explaining how individual state decisions on this provision can best help drive solutions to chronic homelessness.

People working to end homelessness in their communities understand the importance of these and other relevant ACA provisions that fund services for vulnerable people and help safety net systems function more effectively. Now that so much of the ACA conversation is moving to states, it is critical, from a homeless services perspective, to engage and inform mainstream efforts to change Medicaid in states.

With state elected leadership now settled, policymakers are looking at 2013 state budget strategies, as well as actions needed to take advantage of health care reform. As states respond to ACA opportunities, community-based strategies to address chronic homelessness should be highlighted. Messages should convey the opportunities for supportive housing to help stretch the public dollars spent on vulnerable populations.

One first step is to educate new leaders and remind incumbents about the connections between homelessness and the high costs of providing health care to vulnerable people, and to suggest specifically what communities need from innovation in Medicaid and other state health care programs.

As Congress reconvenes to deal with the Fiscal Cliff and Washington gets back to work, the changes and issues that lie ahead will further emerge. The Alliance will, of course, continue to keep our readers posted on these issues and how they might impact the great work and progress being made on the ground.